Congenital CMV infection is a leading cause of hearing loss and brain disease in children and the Institute of Medicine has targeted CMV for vaccine development. Previous studies have suggested that primary maternal infection during pregnancy was the most significant risk factor for damaging congenital infections. However, more recent studies including our previous MCHDR study at Ballabgarh have shown congenital CMV infection occurs at higher rate (1% to 2%) in maternal populations with near universal CMV seroimmunity. These studies have also suggested that CMV-related sensorineural hearing loss (SNHL) occurs in populations with high CMV seroprevalence at a rate similar to that observed in the U.S. and Northern Europe thus, the public health impact of congenital CMV infection in populations of developing countries could be significant. We propose to test the hypothesis that congenital CMV infection contributes to a significant proportion of SNHL in India. This hypothesis will be addressed in two specific aims: (1) To determine the contribution of CMV- related SNHL in infants born at the Comprehensive Rural Health Services Project (CRHSP) in Ballabgarh, India by screening newborns for CMV and hearing loss, and (2) To evaluate the utility of newer, rapid, simple and simple PCR-based methods suitable for newborn CMV screening in resource-poor settings. The presence of an excellent infrastructure at CRHSP, Ballabgarh providing ready access to the study population served by the CRHSP and the ongoing collaborative relationship between the investigators at UAB and at AIIMS provides significant advantage to the proposed studies. In addition, we expect to develop preliminary estimates of SNHL at birth in the rural population and to test the feasibility of newborn hearing screening program at the community level. The proposed studies will provide crucial information about the overall prevalence of hearing loss at birth and the contribution of CMV-related SNHL in the population, an early identification of children at increased risk for SNHL, and the development of intervention strategies for children with SNHL. The proposed research plan also incorporates and emphasizes the training and technology transfer components. PUBLIC HEALTH RELEVANCE: We propose to test the hypothesis that a significant proportion of SNHL at birth or neonatal period in India is secondary to congenital CMV infection. The proposed study will also examine the feasibility of screening newborns for hearing function at the primary health center setting in a rural community. It is expected that the results of this study to provide a reliable estimate of SNHL prevalence at birth in a low-income semi-urban population near New Delhi, India. In addition, we will evaluate simple and reliable methods that can be used in resource-poor settings to screen infants for congenital CMV infection.